Microbiological characteristics of bloodstream infections in a reference hospital in northeastern Brazil / Características microbiológicas de infecções da corrente sanguínea em hospital de referência no nordeste do Brasil

Abstract Routine blood culture is used for the detection of bloodstream infections by aerobic and anaerobic bacteria and by common pathogenic yeasts. A retrospective study was conducted in a public hospital in Maceió-AL, by collecting data of all medical records with positive blood cultures. Out of the 2,107 blood cultures performed, 17% were positive with Staphylococcus coagulase negative (51.14%), followed by Staphylococcus aureus (11.21%) and Klebsiella pneumoniae (6.32%). Gram-positive bacteria predominated among positive blood cultures, highlighting the group of Staphylococcus coagulase-negative. While Gram-negative bacteria had a higher number of species among positive blood cultures.

Resumo A cultura sanguínea de rotina é usada para a detecção de infecções na corrente sanguínea por bactérias aeróbias e anaeróbias e por leveduras patogênicas comuns. Estudo retrospectivo realizado em hospital público de Maceió-AL, por meio da coleta de dados de todos os prontuários com culturas sanguíneas positivas. Das 2.107 culturas sanguíneas realizadas, 17% foram positivas com Staphylococcus coagulase negativo (51,14%), seguido por Staphylococcus aureus (11,21%) e Klebsiella pneumoniae (6,32%). As bactérias Gram-positiva predominaram entre as culturas de sangue positivas, destacando-se o grupo das Staphylococcus coagulase-negativo. Enquanto as bactérias Gram-negativas apresentaram um número maior de espécies entre as culturas de sangue positivas.

Microbiological characteristics of bloodstream infections in a reference hospital in northeastern Brazil

Abstract Routine blood culture is used for the detection of bloodstream infections by aerobic and anaerobic bacteria and by common pathogenic yeasts. A retrospective study was conducted in a public hospital in Maceió-AL, by collecting data of all medical records with positive blood cultures. Out of the 2,107 blood cultures performed, 17% were positive with Staphylococcus coagulase negative (51.14%), followed by Staphylococcus aureus (11.21%) and Klebsiella pneumoniae (6.32%). Gram-positive bacteria predominated among positive blood cultures, highlighting the group of Staphylococcus coagulase-negative. While Gram-negative bacteria had a higher number of species among positive blood cultures.

Resumo A cultura sanguínea de rotina é usada para a detecção de infecções na corrente sanguínea por bactérias aeróbias e anaeróbias e por leveduras patogênicas comuns. Estudo retrospectivo realizado em hospital público de Maceió-AL, por meio da coleta de dados de todos os prontuários com culturas sanguíneas positivas. Das 2.107 culturas sanguíneas realizadas, 17% foram positivas com Staphylococcus coagulase negativo (51,14%), seguido por Staphylococcus aureus (11,21%) e Klebsiella pneumoniae (6,32%). As bactérias Gram-positiva predominaram entre as culturas de sangue positivas, destacando-se o grupo das Staphylococcus coagulase-negativo. Enquanto as bactérias Gram-negativas apresentaram um número maior de espécies entre as culturas de sangue positivas.

Dietary ethanol extract of mango increases antioxidant activity of pork.

Ethanol extract of mango seeds (EEMS) are composed of several polyphenolic compounds with considerable in vitro antioxidant activity that can be used in pig feed and may contribute positively to meat quality characteristics. The aim of this study was to evaluate the effect of EEMS as a source of antioxidants in growing-finishing pig diets on meat quality, lipid stability, sulfhydryl groups non-proteinaceous (SG-NP), total phenolic compounds, total antioxidant potential and total antioxidant activity of meat after 1 and 7 days of refrigeration storage. Thirty-two (60-day-old) barrows, weighing 20.20 ±â€¯1.34 kg, were used in a randomized block design consisting of eight animals with four treatment regimens. Treatments consisted of: Control = no dietary antioxidant; butylated hydroxytoluene (BHT) = diet with 200 ppm BHT; EEMS200 = diet with 200 ppm EEMS; EEMS400 = diet with 400 ppm EEMS. At 145 days of age and average weight of 95.47 ±â€¯6.19 kg, the animals were slaughtered and loin samples were collected and frozen before for qualitative analysis and evaluation of the effect of subsequent storage for 1 or 7 days at 8 °C on lipid stability, SG-NP, phenolic compounds, total antioxidant capacity and total antioxidant activity Meat from animals fed EEMS400 diet showed lower cooking loss (P < 0.0001) and higher non-protein sulfhydryl groups, phenolic compounds and total antioxidant activity at both 1 and 7 days of storage (P < 0.0001) compared to the other treatments. Greater antioxidant capacity was observed at 1 day storage in the meat of animals that consumed EEMS regardless of concentration when compared to the control group (P < 0.01). The dietary inclusion of EEMS to pig diets is more effective at 400 ppm in improving meat quality after cooking and antioxidant parameters of pork.

Survival and prognostic factors in patients with oral squamous cell carcinoma.

BACKGROUND: This study aimed to evaluate sociodemographic and clinical factors influencing overall survival (OS) in patients with oral squamous cell carcinoma (OSCC). MATERIAL AND METHODS: Medical charts of 547 patients with OSCC from a public hospital in northeastern Brazil seen between 1999 and 2013 were evaluated. Survival analysis was performed using the Kaplan-Meier method. The influence of age, sex, ethnicity, clinical stage, anatomical location, type of treatment, and comorbidities on the patients' prognosis was evaluated. Cox proportional hazards regression model was used to identify independent prognostic factors. RESULTS: The 5-year OS was 39%. Multivariate analysis showed that age < 40 years (HR = 2.20; 95%CI: 1.02-4.72) and a single treatment modality (HR = 1.91; 95%CI: 1.37-2.67) were associated with a poor prognosis, while early clinical stage resulted in better outcomes (HR = 0.38; 95%CI: 0.25-0.58). CONCLUSIONS: OSCC patients in advanced clinical stages, diagnosed at a younger age, and submitted to a single therapeutic modality have a poorer prognosis.

Validation of an analytical method for the determination of cadmium (Cd) in fish by atomic absorption spectrometry with electrothermal atomisation.

The validation of an analytical method was carried out for the determination of cadmium (Cd) in fish. The method was based on sample digestion in a microwave oven and subsequent reading using an atomic absorption spectrometer with a graphite furnace. The factorial design of experiments was applied to assess method ruggedness using the methodology of Box et al. [Box GEP, Hunter WG, Hunter JS. 1978. Statistics for experiments: an introduction to design, data analysis and model building. New York (NY): Wiley], studying the influence of sample mass, volume and concentration of acid used for sample digestion and the volume of modifier used. To study the possible matrix effect in the determination of Cd, the standard addition method was also performed. The results were treated using the OLS method. For the normality test a homoskedastic distribution was observed for the developed method and the results were adjusted to the statistical model proposed. F-tests and Student's t-tests indicated that there was no matrix effect on the calibration curve between the concentration range 1.0-10.0 µg Cd l(-1). Parameters such as selectivity, precision, decision limit, detection capability and limit of quantification were established by the method of standard addition to blank samples. The limit of quantification was 6.8 µg kg(-1). Accuracy, which was evaluated by using a certified reference material, was 107.0%. The recovery of the spiked analyte was 93.69% for the concentration of 50 µg kg(-1). Precision was defined by the coefficient of variation observed (Horrat value), estimated in terms of repeatability and reproducibility, and the values were below the limit, which is 2.0. The validation procedure confirmed the suitability of the method.

Genotyping of methicillin-resistant Staphylococcus aureus isolates obtained in the Northeast region of Brazil

Methicillin-resistant Staphylococcus aureus (MRSA) is a major agent of hospital infections worldwide. In Brazil, a multiresistant MRSA lineage (ST239-SCCmecIIIA), the so-called Brazilian epidemic clone (BEC), has predominated in all regions. However, an increase in nosocomial infections caused by non-multiresistant MRSA clones has recently been observed. In the present study, 45 clinical isolates of MRSA obtained from a university hospital located in Natal city, Brazil, were identified by standard laboratory methods and molecularly characterized using staphylococcal chromosome cassette mec (SCCmec) typing and pulsed-field gel electrophoresis. Antimicrobial susceptibility testing was carried out using CLSI methods. The MRSA isolates studied displayed a total of 8 different pulsed-field gel electrophoresis patterns (types A to H) with predominance (73 percent) of pattern A (BEC-related). However, MRSA harboring SCCmec type IV were also identified, 3 (7 percent) of which were genetically related to the pediatric clone - USA800 (ST5-SCCmecIV). In addition, we found a considerable genetic diversity within BEC isolates. MRSA displaying SCCmecIV are frequently susceptible to the majority of non-β-lactam antibiotics. However, emergence of multiresistant variants of USA800 was detected.

Staphylococcus aureus e estafilococos coagulase negativosresistentes à vancomicina em um Hospital Universitário Brasileiro / Vancomycin-resistant Staphylococcus aureus and coagulase-negative staphylococci in a Brazilian University Hospital

Infecções hospitalares por Methicillin-Resistant S. aureus (MRSA) e Methicillin-Resistant Coagulase-Negative Staphylococci (MRCoNS) estão entre as mais frequentes mundialmente, justificando um aumento significativo no uso de vancomicina. Com o objetivo de avaliar a presença de estafilococos resistentes aos glicopeptídeos em pacientes em uso terapêutico desse antimicrobiano, internados no Hospital de Clínicas da Universidade Federal de Uberlândia, Uberlândia MG, foi realizado um estudo longitudinal prospectivo incluindo 41 pacientes, 21 adultos e 20 crianças, entre dezembro de 2000 e março de 2002. O monitoramento microbiológico foi realizado por meio de swabs coletados a partir da cavidade bucal e reto e cultivo primário em Ágar Manitol Salgado acrescido de 6 mg/mL de oxacilina. Amostras selecionadas foram testadas quanto à sensibilidade aos glicopeptídeos pelas técnicas de gel difusão e diluição em ágar e a análise de heterorresistência, pela semeadura utilizando inóculo correspondente à escala 0,5 de McFarland (108 UFC/mL) e análise do perfil populacional. Um único paciente, nefropata em programa de hemodiálise apresentou-se colonizado com uma amostra do fenótipo Vancomycin-Intermediate S. aureus (VISA) (CIM = 8 miug/mL) e em doze, foram isoladas amostras de estafilococos heterorresistentes, correspondendo oito hVISA e quatro hVICoNS. O estudo do perfil populacional, confirmou a presença de subpopulações de células resistentes, sendo seis hVISA e duas hVICoNS. A presença de amostras heterorresistentes à vancomicina pode representar um risco potencial no futuro.

Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-resistant Coagulase-negative Staphylococci (MRCoNS) are among the most frequent hospital infections around the world, and are associated with a significant rise in the use of vancomycin. In order to assess the presence of staphylococci resistant to glycopeptides in patients taking this antibiotic in Uberlândia Federal University Hospital, Uberlândia (MG, Brazil), a prospective longitudinal study of 41 patients (21 adults and 20 children) was performed between December 2000 and March 2002. Microbiological monitoring was carried out by means of swabs collected from the oral cavity and rectum, screened by culturing in Salt Mannitol Agar plus 6 ?g/mL oxacillin. Selected samples were tested for susceptibility to glycopeptides, by the techniques of gel diffusion and dilution in agar, and for heteroresistance, by seeding with an inoculum at a density of 0.5 on the McFarland scale (108 CFU/mL) and performing a population analysis profile (PAP). A single nephropathy patient was colonized with a strain of vancomycin intermediate S. aureus (VISA) phenotype (MIC = 8 miug/mL). In twelve patients, heteroresistant staphylococci were isolated, corresponding to eight hVISA and four hVICoNS. The PAP study confirmed the presence of six hVISA and two hVICoNS. The presence of heteroresistant vancomycin samples may pose a potential risk in the future.

Hospital surface contamination in wards occupied by patients infected with MRSA or MSSA in a Brazilian university hospital

The hospital environment, especially surfaces, represents a secondary reservoir for pathogens such as Staphylococcus aureus. The present study was carried out at the Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU) in Brazil, from January to August 2004, with the aim of qualitatively and quantitatively assessing the presence of S. aureus on surfaces touched by hands (bed rail, bedside table and door handle), on the floor and in the air, in wards where the patients were infected or not infected with this organism. Twenty-six wards with at least one infected patient and 26 wards with uninfected patients were investigated. Surfaces and air were sampled during bedmaking, by means of sterile 10cm2 adhesive tapes and 90mm-diameter exposed culture plates, respectively. Cultures were carried out on Egg Yolk Salt Agar, containing 7.5% NaCl and 1% egg yolk, and colonies identified by lecithinase and coagulase tests and Gramstain. About 50% of the wards were S. aureus contaminated, without significant differences between the groups (46.1% in the infected patient wards versus 53.8% in controls); the correlation between counts of the pathogen on the surfaces and in the air was 66.7%. Inspite of the fact that these bacteria were frequently present in the assessed wards, the microbial density waslow (less than 1 CFU/cm2). The association between environmental contamination and the epidemiology of S. aureus nosocomial infections is complex and thus further investigations are needed to reach a better understanding of this relationship.

A comparative study of the antipyretic effects of indomethacin and dipyrone in rats.

OBJECTIVE: Compare the antipyretic effects of dipyrone and indomethacin. MATERIALS AND METHODS: Fever was induced in rats by i. v. LPS or i. c. v. interleukins (IL), prostaglandins (PG), arachidonic acid (AA), pre-formed pyrogenic factor (PFPF), tumour necrosis factor-alpha (TNF-alpha) or corticotrophin releasing hormone (CRH). Dipyrone and indomethacin were administered i.p., arginine vasopressin V1-receptor antagonist, d(CH2)5 Tyr(Me)AVP, into the ventral septal area. Cyclooxygenase (COX-1/-2) blocking activity was assessed in transfected COS-7 cells. CRH release from isolated hypothalami was determined by ELISA. RESULTS: Indomethacin or dipyrone reduced LPS, IL-1beta, IL-6 or TNF-alpha induced fever and CRH release from rat hypothalamus. Only dipyrone inhibited IL-8, PFPF or PGF2alpha fever. Only indomethacin inhibited fever induced by AA or IL-1beta, plus AA. Neither antipyretic affected fever caused by PGE2 or CRH. d(CH2)5Tyr(Me)AVP only blocked antipyresis induced by indomethacin. Dipyrone at a very high concentration (10 mM) inhibited only COX-1, while indomethacin (0.1 microM) blocked COX-1 and COX-2 in COS-7 cells. CONCLUSION: The antipyretic effect of dipyrone differs from that of indomethacin in that it does not depend on AVP release or inhibition of PG synthesis.

Involvement of CRH in fever induced by a distinct pre-formed pyrogenic factor (PFPF).

OBJECTIVE: This study investigated the role of corticotrophin-releasing hormone (CRH) in mediating the fever induced by a novel pre-formed pyrogenic factor (PFPF), using a CRF antagonist in vivo and evaluating the capacity of PFPF to stimulate CRH release from the hypothalamus in vitro. MATERIALS AND METHODS: Male Wistar rats were used. The PFPF, induced following brief incubation of rat peritoneal macrophages with LPS and retained on 10 or 20 kDa MW cut-off membranes, was injected intracerebroventricularly. Fever was monitored using a rectal probe. Hypothalamus tissue was incubated with PFPF to establish its ability to induce CRH release. The CRH was measured by ELISA. RESULTS: PFPF induced a dose-dependent fever that was abolished by boiling or pronase treatment. Whereas both dexamethasone and indomethacin were effective in reducing interleukin- (IL) 1beta-induced fever, only dexamethasone abolished the fever induced by PFPF. The CRH antagonist, a-helical CRH9-41, abolished the fever induced by synthetic CRH, IL-8 and PFPF but not tumour necrosis factor-a (TNF-alpha). Like IL-1, PFPF was able to induce the release of CRH from rat hypothalamic tissue in vitro. CONCLUSIONS: These results suggest that the fever induced by PFPF depends on CRH release but not prostaglandin synthesis.

Evidence that platelet-derived growth factor may be a novel endogenous pyrogen in the central nervous system.

Platelet-derived growth factor (PDGF) exerts neurotrophic and neuromodulatory actions in the mammalian central nervous system (CNS). Like the cytokines, PDGF primarily signals through tyrosine phosphorylation-dependent pathways that activate multiple intracellular molecules including Janus family kinases. We previously showed that microinjection of PDGF-BB into the lateral ventricle induced a febrile response in rats that was reduced by pretreatment with Win 41662, a potent inhibitor of PDGF receptors (Pelá IR, Ferreira MES, Melo MCC, Silva CAA, and Valenzuela CF. Ann NY Acad Sci 856: 289-293, 1998). In this study, we further characterized the role of PDGF-BB in the febrile response in rats. Microinjection of PDGF-BB into the third ventricle produced a dose-dependent increase in colonic temperature that peaked 3-4 h postinjection. Win 41662 attenuated fever induced by intraperitoneal injection of bacterial lipopolysaccharide, suggesting that endogenous PDGF participates in the febrile response to this exogenous pyrogen. Importantly, febrile responses induced by tumor necrosis factor-alpha, interleukin-1beta, and interleukin-6 were unchanged by Win 41662. Both indomethacin and dexamethasone blocked the PDGF-BB-induced increase in colonic temperature, and, therefore, we postulate that PDGF-BB may act via prostaglandin- and/or inducible enzyme-dependent pathways. Thus our findings suggest that PDGF-BB is an endogenous CNS mediator of the febrile response in rats.

Concentration of electrolytes in the sweat of malnourished children.

The sweat test was performed by the method of Gibson and Cooke on 36 children with second and third degree malnutrition, aged from 2 months to 4 years. The results were compared with those from 32 healthy, well nourished controls in the same age range. Determinations were made of sodium and chloride concentrations, chloride/sodium ratio, and the sum of the concentrations of the two electrolytes in each sample. The malnourished children were found to have higher sodium and chloride concentrations than the well nourished ones. None of the normal or malnourished children had a sweat chloride value greater than 60 mmol/l; chloride values within a suspicious range (between 40 and 60 mmol/l) were found in two malnourished children. Two well nourished controls and six malnourished children showed suspicious sweat sodium concentrations; in one child with third degree malnutrition the sodium content was greater than 60 mmol/l. In all results in the suspicious range, or greater than 60 mmol/l, the chloride/sodium ratio was less than 1, and the sum of the two electrolytes was below 140 mmol/l. Based on these results, we conclude that malnourished children have raised sweat sodium and chloride concentrations when compared with well nourished children. The electrolyte values for most of them are not in a suspicious range or consistent with a diagnosis of cystic fibrosis. Unlike that found in cystic fibrosis, the sodium/chloride ratio in our subjects was less than 1 and the sum of both electrolytes never exceeded 140 mmol/l.

Fecal loss and clearance of alpha-1-antitrypsin in children with persistent diarrhea

1. Daily fecal loss and daily clearance of alpha-1-antitrypsin were determined in 30 infants without intestinal disorders and in 21 with persistent diarrhea. 2. Stools were collected during a 48-h period and a randomly obtained single sample was also collected. Blood samples were also collected from the infants, and alpha-1-antitrypsin was measured by radial immunodiffusion in both stool and serum. 3. No difference in daily fecal loss (mg/d) of alpha-1-antitrypsin was detected between the control group and the group with persistent diarrhea (11 +/- 9.3 vs 18.5 +/- 20 mg/d). No difference in daily alpha-1-antitrypsin clearance (ml/d) was detected between the control group and the group with persistent diarrhea (4.3 +/- 3.6 vs 5.2 +/- 4.8 ml/d). 4. There was a strong correlation between daily fecal loss and daily clearance of alpha-1-antitrypsin (N = 50). There was a weak correlation between the concentrations of alpha-1-antitrypsin in randomly obtained single samples and daily fecal loss of the antiprotease (N = 25; r = -0.183; P < 0.01). 5. We conclude that: a) there is no increased fecal loss of alpha-1-antitrypsin persistent in diarrhea; b) fecal alpha-1-antitrypsin clearance is not necessary to estimate the enteric loss of the antiprotease; c) the determination of alpha-1-antitrypsin in random samples of feces is not a reliable method.

A pre-formed Pyrogenic Factor Released by Lipopolysaccharide Stimulated Macrophages.

The aim of this study was to investigate the pyrogenic activity of factor(s) released by rat peritoneal macrophages following a brief stimulation with LPS. The effect of this factor on the number of circulating leukocytes and serum Fe, Cu and Zn levels, was also evaluated. The possibility that the content of interleukin (IL)-1beta, IL-6 and tumour necrosis factor (TNF) in the supernatant could explain the observations was investigated. Supernatant produced over a period of 1 h by peritoneal macrophages, following a 30 min incubation with LPS at 37 degrees C, was ultrafiltered through a 10 000 MW cut-off Amicon membrane, sterilized, and concentrated 2.5, 5, 10 and 20 times. The intravenous (i.v.) injection of this supernatant induced a concentration-dependent fever in rats with a maximal response at 2 h. The pyrogenic activity was produced by macrophages elicited with thioglycollate and by resident cells. The supernatants also induced neutrophilia and reduction in Fe and Zn 6 h after the injection. Absence of activity in boiled supernatants, or supernatants from macrophages incubated at 4 degrees C with LPS, indicates that LPS was not responsible for the activity. In vitro treatment with indomethacin (Indo), dexamethasone (Dex), or cycloheximide (Chx) did not modify the release of pyrogenic activity into the supernatant or its effects on the reduction in serum metal levels. Although Chx abolished the production of mediator(s) inducing neutrophilia, and Dex reduced the induction of IL-1beta, TNF and IL-6, injection of the highest concentration of these cytokines detected in the supernatants did not induce fever. In vivo treatment with Dex, but not Indo, abolished the fever induced by the supernatant. These results suggest that macrophages contain pre-formed pyrogenic mediator(s), not related to IL-1beta, IL-6 or TNF, that acts indirectly and independently of prostaglandtn. It also seems likely that the pyrogenic activity is related to the factor responsible for the reduction of serum Fe and Zn levels, but not the neutrophilia.

Etomidato e fentanil em cirurgia cardíaca / Etomidate and fentanyl in cardiac surgery

Estudaram-se os efeitos do etomidato como agente de induçäo em 20 pacientes submetidos à cirurgia cardíaca com circulaçäo extracorpórea. Verificou-se que os efeitos hemodinâmicos foram mínimos quando se empregou 50 micrograma.kg-1 de fentanil. Chama-se atençäo a utilizaçäo do flunitrazepam (0,03 mg.kg-1) como medicaçäo pré-anestésica, contribuindo para uma suave induçäo com etomidato. Concluiu-se que o etomidato é excelente opçäo para induçäo em pacientes portadores de coronariopatias e submetidos à cirurgia cardíaca